Nurse Auditor - Medical Bill Review
New
R
Rising Medical SolutionsMedical cost containment
Workable workplace: remoteFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 3-5 years of clinical experience
Requirements
- Hold an active RN or LPN professional license, or equivalent, within states of operation.
- Have 3-5 years of clinical experience in acute care, surgery, and/or orthopedics.
- Understand CPT and ICD-10 codes and Medicare guidelines.
- Be able to apply knowledge to state fee schedules.
- Have specialized training in hospital coding, orthopedics, neurology, rehabilitation, or emergency room procedures.
- CPC and/or CPC-H certifications are strongly desired.
- Workers’ Compensation medical bill review experience is a major plus.
- Experience with deposition or litigation cases is a plus.
- Bring a customer service orientation, including strong communication skills.
Responsibilities
- Audit medical and billing records to determine whether services provided are reasonable, appropriate, and necessary.
- Clinically identify and evaluate charges that are not related to the occurrence.
- Verify that charges correspond to services ordered and authorized.
- Initiate appropriate contacts with clients and medical providers.
- Negotiate bills.
- Conduct re-evaluation reviews as required.
- Evaluate medical records and billing statements to provide clients with information for determining case value.
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